An Overview of Consent to Reproductive Health Services by Young People

Background

The ability of people younger than 18 (generally, the legal definition of a minor) to consent to a range of sensitive health care services—including sexual and reproductive health care, mental health services, and alcohol and drug abuse treatment—has expanded dramatically over the past several decades. This trend reflects the recognition that, while involving parents or guardians in young people’s health care decisions is desirable, many young people will not avail themselves of important services if they are forced to involve their parents. With regard to sexual and reproductive health care, many states explicitly permit all or some people younger than 18 to obtain contraceptive, prenatal and STI services without parental involvement. Moreover, nearly every state permits parents younger than 18 to make important decisions regarding their children. In sharp contrast, a majority of states require parental involvement before a legal minor can obtain an abortion.

Notably for access to contraceptives for those younger than 18, the U.S. Supreme Court specifically affirmed their right to access contraceptives in the 1977 decision Carey v. Population Services International. No state has enacted a blanket requirement that individuals must obtain parental consent for contraceptive services. For laws related to HIV and other STI services, pregnancy care, adoption or medical care for a child, state consent laws apply to all individuals aged 12 through 17. In some cases, however, states allow only certain groups of young people—such as those who are married, pregnant or already parents—to consent. Several states have no relevant policy or case law; in these states, physicians commonly provide medical care without parental consent to individuals younger than 18 they deem mature, particularly if the state allows minors to consent to related services. The following chart tracks seven areas in which state laws can affect a young person’s right to consent. For further information on each issue, click on the column heading.

Further information on these issues can be obtained by clicking on the column headings.

Highlights

26 states and the District of Columbia explicitly allow all individuals to consent to contraceptive services or those at a specified age (such as 12 or 14) and older to consent to such care.

20 states allow only certain categories of people younger than 18 to consent to contraceptive services.

4 states have no explicit policy or relevant case law.

STI services:

All states and DC allow young people to consent to STI services.

39 states and DC allow all individuals, regardless of age, to consent to STI and HIV services, while the remaining states allow certain categories of young people or those at a specified age (such as 12 or 14) and older to consent to such care.

18 states allow, but do not require, a physician to inform a young person’s parents that he or she is seeking or receiving STI services when the doctor deems it in the patient’s best interests.

Prenatal care:

32 states and DC explicitly allow all individuals younger than 18 to consent to prenatal care.

13 of these states allow, but do not require, a physician to inform parents that their child is seeking or receiving prenatal care when the doctor deems it in the young person’s best interest to do so.

North Dakota allows young people to consent to prenatal care during the first trimester and requires parental consent for most care during the second and third trimesters.

4 states allow young people who can be considered “mature” to consent to receive care.

13 states have no explicit policy or relevant case law.

Adoption:

28 states and the District of Columbia allow all parents, regardless of age, to choose to place their child for adoption.

5 states require the parent of a minor consenting to an adoption to be notified before the adoption takes place or to consent to the adoption.

5 states require the involvement of legal counsel or a guardian ad litem.

12 states have no explicit policy or relevant case law.

Medical care for a child:

30 states and the District of Columbia allow all parents, regardless of age, to consent to medical care for their child.

20 states have no explicit policy or relevant case law.

Abortion:

2 states and the District of Columbia explicitly allow all individuals to consent to abortion services, regardless of age.

21 states require that at least one parent provide consent before a patient younger than 18 can obtain an abortion, while 11 states require prior notification of at least one parent.

5 states require both notification of and consent from a parent before a minor’s abortion.

6 states have parental involvement laws that are temporarily or permanently enjoined.

Notes: "All" applies to all individuals or to those at a specified age (such as 12 or 14) and older. “Some” applies to specified categories of young people (those who have a health issue, or are married, pregnant, considered mature). Totals include only those states that allow all individuals to consent.

▼Permanently enjoined by court order; law not in effect.

* Physicians may, but are not required to, inform the young person’s parents.

†Applies to individuals 14 and older. Hawaii allows individuals aged 14 and older to consent to STI care and allows all individuals, regardless of age, to consent to HIV/AIDS care.

‡Delaware’s abortion law applies to women younger than 16. Oregon’s prenatal care law applies to women at least 15 years old. South Carolina’s abortion law applies to those younger than 17.

Ω A court may require parental consent.

β New Jersey allows all individuals, regardless of age, to consent to STI care and allows individuals aged 13 or older to consent to HIV/AIDS care.

ξIndividuals younger than 18 may consent to prenatal care in the first trimester and the first visit after the first trimester. Parental consent required for all other visits.